GENERAL INFORMATION

Malignant Fibrous Histiocytoma was first described in the 1960s presumably derived from a mixed histiocytic and fibroblastic cellular origin but is it now believed that it is a lesion derived from fibroblast differentiation. It is a malignant neoplasm (sarcoma) of mesenchymal/spindle origin. It is a high gade sarcoma with a strong potential for metastatic disease. Since the beginning MFH was recognized as a heterogeneous group of tumors with varying histology affecting both genders and all ages. Since 1978, MFH it was identified as the most common soft tissue sarcoma after Weiss and Enzinger published the first large series of tumors with those characteristics.
Four different sub-types have been described: Storiform-pleomorphic, Myxoid, Giant cell and Inflammatory. It is now often referred to as Undifferentiated Pleomorphic Sarcoma (UPS).

Of these, the storiform-pleomorphic is the most common type, accounting for up to 70% of the cases. The myxoid variant is the second most common accounting for approximately 20% of cases. After 2002 The World health Organization suggested replacing the term MFH with Undifferentited high-grade pleomorphic sarcoma (UPS). Myxoid MFH is now myxofibrosarcoma. Giant cell MFH and inflammatory MFH are now called UPS with giant cells and UPS pleomorphic sarcoma with prominent inflammation, respectively.

CLINICAL DATA

Comprises 20% - 30% of soft tissue sarcomas
Second most common type of soft tissue sarcoma
Most commonly arises from the soft tissues but may arise from bone.
Most common soft-tissue sarcoma in adults though it can appear at any age. Very rare in patients < 20 year old.
Most common sarcoma after radiation.
Heterogeneous tumor in histology and prognosis
Early osseous invasion and metastases to regional lymph nodes may occur

CLINICAL PRESENTATION

Signs/Symptoms
Rapidly enlarging, painless mass. 30% of patients may have dull aching pain or tenderness.
Some patients report trauma in the affected area (trauma does not cause MFH) and the MFH may be misconstrued as a hematoma or muscle strain
Systemic symptoms are not expected.

Prevalence
Male predilection (70%)
More frequent in caucasion population

Age
Most cases occur between 50 and 70 years old.
Extremely rear in children.

RADIOGRAPHIC PRESENTATION

Deep intramuscular soft mass
Average size of 5 to 10 cms.
Heterogeneous mass
Osseous involvement is frequent
Regions of mineralization may be demonstrated on plain x-rays but is unusual for an MFH
In some cases, MFH can be more aggressive and invade an adjacent bone.

Plain x-ray
Demonstrate a soft tissue mass density.
Curvilinear or punctate mineralization may be observed in 5 to 20% of patients.
Heterotopic bone formation may rarely be present along the periphery of the mass.
It is not the ideal method of study in cases of MFH.

Fig. 7 Microscopic Pathology: Low (A), medium (B) and high magnification (C) E&H staining demonstrate a hypercellular spindle call neoplasm with large nuclei and scant cytoplasm as well as significant nuclear pleomorphism and abundant atypical mitotic figures. There are many bizarre appearing large cells. It is possible to identify multiple giant cells mixed with spindle cells. There is fibrous tissue admixed with the cells (fibrous stroma). The cells and fibrous tissue are arranged in a storiform or swirling arrangement.

Testimonials

"Thank you from the bottom of my heart for your excellent care...I wish you a very long and productive professional life so that more people can benefit from your expertise, so that more people can get a second chance to live their lives to the fullest."

Irina B.

"I am writing to you to thank you for everything you and your team have done for me. I cannot tell you how fortunate I feel that I am in your care. It gives me the peace of mind that I have you as my doctor. Your knowledge and expertise is greatly appreciated. You truly are the best! Thank you!"

-Sincerely,
JG

Dear Dr. Wittig,
I am writing at a loss to find adequate words to thank you for all that you have done for me. You were so generous to give up your time on a weekend to operate on my femur. I believe that this made a vast difference in my life. Your skills as a diagnostician and surgeon have given me an opportunity to have a better life. At a time like this, it is comforting to be treated with kindness and skill. Thank you for sharing your gifts with me.

Dear Dr. Wittig,
I'm so thrilled with your diagnosis, and thankful too! If you're ever in S. Orange and would like to visit "The Gate" for a pint, I'd be happy to personally escort you. You'll get the VIP treatment. Thank you so very much for your attention and professionalism.

Dear Dr. Wittig,
I can't thank you, and your team enough for making our son, who recently underwent surgery (removing a tumor on his pelvis), feel so comfortable and at ease. As did you, with my family, addressing all our questions, and concerns. We knew he as in the best possible hands. You are a wonderful, compassionate Doctor....We are so grateful to have such a gifted Dr. taking care of him.
Sincerely,
Sandy

Dear Dr. Wittig,

Thank-you so very much for being my surgeon for that chondrosarcoma, for saving my life! And I have learned over the months (from other doctors...) that I was very fortunate to have you as a surgeon.

I think that I should have been more cheerful and clear upon receiving the good news from you during the visit on Wednesday.--I was just that I've been so anxious, worried, tense, confused from 6 months of various treatments -- prostate 45 day radiation, gall stone passing, kidney stone matters that have been happening these past months.

In driving home after the news today, I've begun feeling increasingly released, cheerful...able at long last to get on fully with my life.

You, your staff, that hospital...have set the bar for health care so much higher than I could have imagined.

With Deepest Gratitude!

Robert

Good evening Dr. Wittig,

I hope you are doing well this evening and hope you have a restful weekend with your family. It was a pleasure meeting you in person. After meeting you, I can understand why you and Sheeraz are close friends and colleagues, especially how highly Sheeraz spoke of you! You are kind and down to earth. Also, you and Sheeraz are not only amazing and talented doctors, but you are compassionate and empathetic to the needs of your patients and families, which often lacks in the world of medicine. I wanted to be a doctor, but I really can't deal with the sight of blood, like I mentioned to Sheeraz. Both of you are great role models how family centered care should be and how I strive and want to be with my little patients at Sloan.

I appreciate everything you have done for my Uncle. I am grateful to Sheeraz for recommending you! I hope you and your family are always happy and healthy, so you can continue to great things to impact the quality of life of others...

Thanks so much again for everything NYU familia!

Kind Regards,
Mariyam

On May 10th I had the pleasure of meeting Dr. Wittig for the first time. This was an extremely stressful time for me since I had received several reports regarding my cancer diagnosis. Upon meeting Dr, Wittig I immediately knew I was in good hands. His calm demeanor & straightforward manner were very comforting to me. He laid out how he was going to proceed with the operation, how long it would take, & followup. He has been a source of comfort to me thru out this ordeal & I know I could not be in a better place with him. His support staff of nurses, is top notch. Their attention to detail, answering questions we may have, are always done in a timely manner. Without the ease of working with Dr. James Wittig, I can tell you. I would not feel as confident with my situation as I do. He is truly a very special human being. Sincerely, Karolyn